Multipl Miyelom Tanılı Hastada Fournier Gangreni ve Hemşirelik Bakımı: Olgu Sunumu

Öz

Multipl Miyelom Tanılı Hastada Fournier Gangreni ve Hemşirelik Bakımı: Olgu Sunumu Öz Multipl miyelom, kemik iliğinde üretilen plazmanın anormalleşmesi sonucu ortaya çıkan, hematolojik malignitelerin yaklaşık %10'unu oluşturan bir kanser türüdür. Fournier gangreni ise perineal, genital ve perianal alanda hızla ilerleyen, nekrotizan ve yaşamı tehdit eden bir hastalıktır. Hemşirelerin, multipl miyelom ve Fournier gangreni olan hastada, bireysel bakım sürecini iyi bir şekilde yönetebilmeleri oldukça önemlidir. Çalışmada, multipl miyelom tanılı 63 yaşındaki erkek hastada gelişen Fournier gangreninin tedavi süreci ve hemşirelik bakımı sunulmaktadır. Olguda Kuzey Amerika Hemşirelik Tanıları Birliği-NANDA kapsamında ele alınan hemşirelik tanıları “Doku bütünlüğünde bozulma, Akut ağrı, Özbakım eksikliği, Beslenmede değişim: Gereksinimden az, Sıvı elektrolit dengesizliği, Kan glukoz düzeyinde değişim, Anksiyete, Bilinç düzeyinde değişim, Fiziksel mobilitede bozulma, Bilgi eksikliği, Aspirasyon riski, Düşme riski” şeklindedir. Sonuç olarak çalışmada, multipl miyelom tanılı hastalarda Fournier gangreni gibi kritik hastalıkların erken tanı, hızlı cerrahi müdahale ve multidisipliner tedavi ile yönetimi vurgulanmaktadır. Hemşireler, multidisipliner ekip içinde aktif rol alarak, bireyselleşmiş ve kanıta dayalı bakım ile hastaların iyileşmesinde önemli katkılar sunmaktadır. Anahtar kelimeler: fournier gangreni, hemşirelik bakımı, multipl miyelom. Destekleyen herhangi bir kurum bulunmamaktadır.

Anahtar Kelimeler

• fournier gangreni
• hemşirelik bakımı
• multipl miyelom.

Fournier's Gangrene and Nursing Care in a Patient Diagnosed with Multiple Myeloma: A Case Report

Öz

Fournier's Gangrene and Nursing Care in a Patient Diagnosed with Multiple Myeloma: A Case Report Abstract Multiple myeloma is a hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow, accounting for approximately 10% of all blood cancers. Fournier’s gangrene, in contrast, is a rapidly progressive, necrotizing soft tissue infection that affects the perineal, genital, and perianal regions and carries a high risk of mortality. Both conditions present significant complexities in treatment and care, necessitating a comprehensive and multidisciplinary approach. The effective management of patients with multiple myeloma complicated by Fournier’s gangrene requires a multidisciplinary approach, with nurses playing a pivotal role in delivering individualized and evidence-based care. This study presents the treatment process and nursing interventions for a 63-year-old male patient diagnosed with multiple myeloma who subsequently developed Fournier’s gangrene. Nursing diagnoses, based on the North American Nursing Diagnosis Association (NANDA) framework, included impaired tissue integrity, acute pain, self-care deficit, imbalanced nutrition: less than body requirements, fluid and electrolyte imbalance, altered blood glucose level, anxiety, altered level of consciousness, impaired physical mobility, knowledge deficit, risk for aspiration, and risk for falls. This study emphasizes the importance of early diagnosis, prompt surgical intervention, and a multidisciplinary approach in managing critical conditions such as Fournier’s gangrene in patient diagnosed with multiple myeloma. Keywords: Fournier gangrene, nursing care, multiple myeloma. There is no funding to support this study.

Anahtar Kelimeler

• Fournier gangrene
• nursing care
• multiple myeloma.

Destekleyen Kurum

There was no support from any organization.

Etik Beyan

The patient and their relatives were informed about the case report, and an informed voluntary consent form was signed.

Kaynakça

1. Altuntaş, F., Korkmaz, S. (2018). Multiple miyeloma 2018 güncelleme. Ankara: Hematoloji Üniversitesi Yayınları.
2. American Cancer Society (ACS). (2025). Multipl miyeloma nedir? | Plazma hücreli kanser. ACS-American Cancer Society. Retrieved from https://www.cancer.org/cancer/types/multiple-myeloma/about/what-is-multiple-myeloma.html
3. American Society of Hematology. (2025). Myeloma. Retrieved from https://www.hematology.org/education/patients/blood-cancers/myeloma
4. Bowring, I. A., Bouwman, L., van Putten, K., & Blok, J. J. (2025). Fournier’s gangrene after male circumcision: A case report. Urology Case Reports, 59, 102950. doi:10.1016/j.eucr.2025.102950
5. Caviş, M. (2024). Fournier gangreni mi, değil mi? In A. Savrun, F. Tanrıverdi, Ş. T. Savrun, & F. Kulaksız (Eds.), Acilde zor vakalar (1st ed., pp. 49–64).
6. Cleveland Clinic. (2025). Fournier’s gangrene. Retrieved from https://my.clevelandclinic.org/health/diseases/22025-fourniers-gangrene
7. Creta, M., Sica, A., Napolitano, L., Celentano, G., La Rocca, R., Capece, M., et al. (2021). Fournier’s gangrene in patients with oncohematological diseases: A systematic review of published cases. Healthcare (Basel), 9(9), 1123. doi:10.3390/healthcare9091123
8. Danacı, E., & Koç, Z. (2022). Fournier gangreni tanısı alan bireyin hemşirelik bakımı: Olgu sunumu. Sağlık ve Sosyal Yardım Vakfı Dergisi, 32(1), 221–236. Retrieved April 20, 2025, from https://ssyv.org.tr/wp-content/uploads/2022/04/23-Fournier-Gangreni-Tanisi-Alan-Bireyin-Hemsirelik-Bakimi-Olgu-Sunumu.pdf

9. El-Qushayri, A. E., Khalaf, K. M., Dahy, A., Mahmoud, A. R., Benmelouka, A. Y., Ghozy, S., et al. (2020). Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis. International Journal of Infectious Diseases, 92, 218–225. doi:10.1016/j.ijid.2020.01.026
10. Ernstmeyer, K., & Christman, E. (Eds.). (2021). Nursing skills (Chapter 20: Wound care). Eau Claire, WI: Chippewa Valley Technical College. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK593201/
11. Ferlay, J., Ervik, M., Lam, F., Laversanne, M., Colombet, M., Mery, L., et al. (2024). Global Cancer Observatory: Cancer today. Lyon, France: International Agency for Research on Cancer. Retrieved from https://gco.iarc.who.int/today
12. Geres, H., & Kotchetkov, R. (2020). Nursing in patients with hematological malignancies. International Journal of Hematology & Oncology, 9(1), IJH24. doi:10.2217/ijh-2020-0011
13. Global Cancer Observatory (GLOBOCAN). (2022). Fact sheets: Populations. Retrieved from https://gco.iarc.who.int/today/en/fact-sheets-populations#countries
14. Graf, H., Luger, A., Pflüger, H., Syre, G., & Gebhart, W. (1983). Fournier-Gangrän: Eine seltene Komplikation bei multiplem Myelom [Fournier gangrene: A rare complication of multiple myeloma]. Hautarzt, 34(6), 289–291. PMID: 6874336.
15. Hughes, T., Bowen, D., Saeed, K., Juliebø-Jones, P., & Somani, B. (2023). Management of Fournier’s gangrene: A practical guide for clinicians. British Journal of Hospital Medicine (London), 84(9), 1–9. doi:10.12968/hmed.2023.84.9.1
16. Leslie, S. W., Rad, J., & Foreman, J. (2023). Fournier gangrene. Clinical Case Reports, 3(3), 198–199.
17. Lorenzo-Ruiz, I. (2024). Nursing care plan for a patient with Fournier's gangrene: Clinical case. Enfermería Intensiva (English Edition), 35(3), 242–249. doi:10.1016/j.enfie.2023.12.003
18. Nonaka, K., Kawase, K., Takagi, K., Takatsu, Y., Maniwa, K., Takao, C., et al. (2024). Development of Fournier’s gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report. Medicine (Baltimore), 103(30), e38688. doi:10.1097/MD.0000000000038688
19. Pecorino, A., Grossi, U., Picone, T., Iacomino, A., Mammano, E., & Sarzo, G. (2024). Management of a complex case of Fournier’s gangrene in a female patient with ulcerative colitis. Techniques in Coloproctology, 28(1), 155. doi:10.1007/s10151-023-02810-y